Modification of mediators of immune reaction after general anaesthesia.

UNLABELLED: The adverse reactions that may occur during a surgical intervention are of concern to anesthesiologists and allergists due to the civil responsibility they entail and the increased demand for healthcare in allergology units. The aim of the present study was to determine the prevalence of adverse reactions in our setting (Island of Lanzarote) and modifications to immune response mediators using three types of representative myorelaxants (succinylcholine, cisatracurium and vecuronium) in order to predict and prevent adverse reactions. MATERIAL AND METHODS: We performed a prospective, cross sectional, observational study in a population of 201 patients scheduled to undergo surgery in the Surgery Department of the Lanzarote General Hospital from October 1998. Three groups were retrospectively selected: vecuronium (73 patients), cisatracurium (80 patients), and succinylcholine (48 patients). Blood was extracted from all patients before and after the intervention and the following in vitro variables were evaluated: histaminemia, eosinophil cationic protein, tryptase, IgE to latex, CD4/CD8 fractions, total lymphocytes, total IgE, C3 and C4, and also the histaminuria. CONCLUSIONS: The mean age of the patients was 41 years with a predominance of women. Sixty percent had not previously undergone surgery. The mean operating time was 2 hours. Digestive surgery accounted for the greatest number of interventions (38.8 %) and most of the patients had no personal history of atopy (91.5 %). The greatest number of perioperative reactions was produced by cisatracurium (38.8 %), followed by succinylcholine (27.4 %) and vecuronium (20 %). The reactions observed were immediate type 1 and 2 reactions. All reactions were reversible without sequelae. Histaminuria levels were significantly decreased in the cisatracurium group. Histaminemia and eosinophil cationic protein showed no significant changes in any of the three groups. Tryptase concentrations in blood did not increase in the postoperative period in any of the three groups. On the contrary, concentrations were significantly lower than basal values. In the vecuronium and succinylcholine groups, CD4/CD8 fractions decreased in the postoperative period. Total lymphocytes decreased in all three groups. Total IgE tended to decrease in the cisatracurium and succinylcholine groups. IgE to latex was negative in the three groups. Specific IgE to succinylcholine was unmodified. C3 complement fraction was unmodified in all three groups and C4 fraction was reduced in the vecuronium group. In our setting and in our patients, the three myorelaxants produced immunosuppression of immune response mediators. The present study confirms that tests for allergy to myorelaxants are not indicated in the preoperative period.

Chronic angioedema. Three relevant cases.

Three cases of clinical angioedema are reported in which the etiopathogenetic involvement of qualitative and quantitative complement disorders was demonstrated. The first patient had a functional deficit in C1 inhibitor, the second had a decrease in CH50, and the third, a reduction in the C1q, C3, and C4 fractions. The cases are interesting because of occasional difficulties in the causal diagnosis, the severity of the symptoms, which can include laryngeal edema, and, finally, the favorable outcome achieved with correct medication, which did not include antihistamines or steroids. The clinical picture of hereditary angioedema is characterized by the familial occurrence of the process, although this apparently was absent in these cases. Two patients experienced laryngeal edema and none had abdominal manifestations. The treatment of choice for angioedema of these characteristics is antifibrinolytic agents, which achieve good results in 70% of the patients. Epsilon-aminocaproic acid and tranexamic acid inhibit the formation of plasmin and fragments of the Hageman factor, thus inhibiting kallikrein and bradykinin production. The androgens danazol and stanazolol have been used since the 1970s, and stanazolol proved to be very effective in two of our patients.

[Prevalence of sensitization to Blomia in Gran Canaria]. / Prevalencia de sensibilizaciones a Blomia en Gran Canaria.

In the present study we assessed the prevalence of sensitizations to Blomia in our environment. Perennial climatological conditions in the Canarian Islands facilitates the habitat to mites. The Blomia is found in tropical and subtropical homes of Europe, USA and Asia like the Dermatophagoides. We have designed a transversal and prospective study on 100 patients who consulted our Unit for the first time. A Prick-test for the common allergens, including Blomia Kulagini, and in vitro determination of total and specific IgE to Dermatophagoides Pteronyssinus and Farinae, was performed in those patients showing the same or higher levels than class 3 CAP System RAST-Fesa against Blomia Tropicalis. Results achieved in our environment and our patients are the following: 1. Prevalence of sensitizations to BK in patients who consult for the first time is 50%. 2. The specific IgE immunologic response to BK is 56% (45 patients). 3. Scarce correlation in the papule areas and specific IgE levels between BT and DTP (p = 0.22020); BT and DFA (p = 0.09063). Table VI. Fig. I and II. 4. These results and previous studies of allergenization suggest poor crossed reactivity between Blomia and Dermatophagoides. 5. We think that Blomia is a new etilogic agent of the allergic respiratory disorders in our environment and therefore it should be included in the standard set of allergens from a diagnostic and therapeutical point of view. We keep studying its identification and count in dust samples from our homes, as well as the crossed reactivity, by RAST inhibition, with other acari.

A new method of administration of topical nasal extracts. Immunoaerosol therapy.

Topical nasal immunotherapy (TNI) is a therapeutic option in residual rhinitis. Adverse reactions are common with pollen extracts and often are related to the phenol and thimerosal conservatives. This study sought to determine the clinical effectiveness of two methods of administration of TNI. Twenty-eight patients with allergic perennial rhinitis treated for 2 years with parenteral semidepot immunotherapy were divided into two groups of 14 patients: group A receiving conventional aerosol nebulization (TNE), and group B, which received TNAI using a type F aerosol electrocompressor. Clinical response and tolerance to TNI were evaluated using scores for signs and symptoms. The conclusions were: Both group A and group B exhibited statistically significant differences between baseline and post-immunotherapy parameters (p < 0.001). There were no statistically significant differences in the degree of improvement achieved in the two groups. The main advantages of TNAI were better tolerance of the D. pteronyssinus extracts, perhaps due to the elimination of conservatives, and the guarantee of correct administration of the dose and control of minimum reactions. For these reasons it is a viable therapeutic option in allergic perennial rhinitis previously treated for two years with parenteral semidepot immunotherapy.

[Immunologic clinical evaluation of a biological response modifier, AM3, in the treatment of childhood infectious respiratory pathology]. / Valoración clínica inmunológica de un modificador de la respuesta biológica, AM3, en el tratamiento de la patología respiratoria infecciosa infantil.

To assess the immunoclinical effectiveness of a biological response immunomodulator, we used AM3 (glycophosphopeptide ), a glucomannan polysaccharide extracted from the cell wall of a strain of Candida utilis, in 20 children with asthmatic bronchitis. They received 2 envelopes (1 g) daily for 4 months. The results were compared with a control group of 20 untreated children with the same pathology. The following clinical and immunological parameters were assessed in all of them: cough, dyspnea, expectoration, frequency and intensity of the bronchospasm, time of administration of the symptomatic medication, and the delayed cutaneous cells response by means of the intradermal reaction of 5 antigens (Trichophyton, Candida albicans, tuberculin, E. coli and bacterial antigens). In the treated group, the immunoferon (AM3) reduced the symptoms, the intensity and frequency of the bronchospasm, and the symptomatic medication (table I, II and III). In basal conditions, the 40 children presented a state of 75% anergy; after 4 months of treatment, the treated group experienced a 45% decrease in their anergic situation, variation which was statistically significant when compared with the control group. In our 20 treated patients, AM3 behaved like and immunostimulant, improving the clinical situation and progress in patients with infectious respiratory disorders. We consider that the immunoferon constitutes a coadjuvant therapy to bacterial immunotherapy.

Skin cross-reactivity between Dermatophagoides pteronyssinus and storage mites in atopic children.

In our environment, some children with allergic respiratory pathology do not have as favorable an evolution as expected after three years of immunotherapy with D. pteronyssinus extracts. We believe this is due to the existence of other mites whose antigenic determinants are not present in D. pteronyssinus. The purpose of the present study was to evaluate skin cross-reactivity between Dermatophagoides and storage mites in children with bronchial asthma. Fifty patients were chosen, with a mean age of 7.78 +/- 2.98 years and a range of 3-14 years. There were 38 boys (76%) and 12 girls (24%) with rhinitis and bronchial asthma. All patients had skin tests and prick tests with the following extracts performed on them: house dust (HD), Dermatophagoides farinae (DFA), Dermatophagoides pteronyssinus (DPT), Acarus siro (AS), Glycyphagus domesticus (GD), Lepidoglyphus destructor (LD), Tyrophagus putrescentiae (TP), with negative and positive controls. The areas of the papulae were evaluated in crosses, according to the size of the histamine and using computerized papulometry, using the Kurta series one graphic tablet with one resolution of 200 points per inch. The data were processed with the "Image-pro" analysis image program. The following conclusions were obtained from our study: 1) No case of skin sensitization to storage mites was found in any of our 50 patients, without house dust and/or Dermatophagoides mites also being present. 2) The greatest skin response with regard to histamine was found for DFA (52%), DPT (44%), HD (22%), GD (10%), AS (4%) and GF (2%).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative clinical-immunological study of oral and subcutaneous immunotherapy in children with extrinsic bronchial asthma.

There is discrepancy of criteria regarding the clinical immunological efficacy of allergenic extracts, administered by oral way, for the control of allergic symptoms of the respiratory airways. The predominant mono-sensitization to D. pteronyssinus and the early development of allergic respiratory symptoms in our medium motivated us to evaluate the clinical-immunological efficacy of oral immunotherapy in children with bronchial asthma. Twenty-eight patients affected with extrinsic bronchial asthma to D. pteronyssinus were included in our study; their average age was 27.93 months (range between 18-42 months) and the SD (standard deviation), 5.46. For the reception of oral and subcutaneous vaccines, made-up of 100% D. pteronyssinus, the patients were divided into two groups of 14 children each. The clinical immunological evaluation was realized in basal conditions, 6 and 12 months after the initiation of both vaccines. IgE and seric IgG4 against D. pteronyssinus was quantified through RAST. The results obtained were as follows: 1. Subcutaneous immunotherapy (SI) was seen to be more effective than oral immunotherapy (OI), throughout the 12 months of the study. 2. In both vaccines, the IgE against D. pteronyssinus did not undergo any statistically significant changes (p less than 0.766 and p less than 0.246). 3. IgG4 against D. pteronyssinus increased more with subcutaneous than with oral therapy. There were statistically significant differences for both kinds of therapy at 6 and 12 months, the difference between basal and 12 months being p less than 0.001 and p less than 0.020, for subcutaneous and oral therapy respectively.(ABSTRACT TRUNCATED AT 250 WORDS)